Femoral neck fracture
Background
- Common in older patients with osteoporosis; rarely seen in younger patients
Proximal
- Intracapsular
- Extracapsular
Clinical Features
- Typically minimal bruising (intracapsular)
- If fractured and displaced: externally rotated and shortened
- If non-displaced: patient may be ambulatory
Differential Diagnosis
Hip pain
Acute Trauma
- Femur fracture
- Proximal
- Intracapsular
- Extracapsular
- Shaft
- Mid-shaft femur fracture (all subtrochanteric)
- Proximal
- Hip dislocation
- Pelvic fractures
Chronic/Atraumatic
Evaluation
30% of patients with symptoms suggestive of fracture but negative x-rays have fracture on MRI
Location of femur fractures
- Consider AP pelvis in addition to AP/lateral views to compare contralateral side
- Consider MRI if strong clinical suspicion but negative x-ray
Management
General Fracture Management
- Acute pain management
- Open fractures require immediate IV antibiotics and urgent surgical washout
- Neurovascular compromise from fracture requires emergent reduction and/or orthopedic intervention
- Consider risk for compartment syndrome
Specific Management
- Ortho consult
- Skeletal traction is contraindicated (may compromise femoral head blood flow)
Disposition
- Admit
See Also
References
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